<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html dir="ltr" xmlns="http://www.w3.org/1999/xhtml">
<%@include file="/WEB-INF/taglibs/common/taglibs.jsp" %>

<head>
    <title><spring:message code="sp.reprint_check.title"/></title>
    <meta content="text/html; charset=utf-8" http-equiv="Content-Type"/>
    <link rel="stylesheet" href="<c:url value="/css/styles.css"/>"/>
    <script src="<c:url value="/javascripts/common.js"/>"></script>
</head>

<body>
<div class="page">
    <%@include file="../../top_menu.jsp" %>
    <table width="100%">
        <tr>
            <td>
                <c:import url="/WEB-INF/jsp/menu/checks_menu.jsp"/>
            </td>
        </tr>
        <tr>
            <td>
                <c:import url="/WEB-INF/jsp/menu/print_checks_menu.jsp"/>
            </td>
        </tr>
        <tr>
            <td>
                <%@include file="/WEB-INF/jsp/include/messages.jsp" %>
                <br/>
            </td>
        </tr>
        <tr>
            <td>
                <form id="role" method="post">
                    <%@include file="../common/search_checks.jsp" %>
                    <p>&nbsp;</p>


                    <table width="985" class="formTable">
                        <tbody>
                        <tr class="formHeader">
                            <td colspan="7"><spring:message code="sp.reprint_check.label.bad_check"/></td>
                        </tr>
                        <tr>
                            <td width="117" height="28" class="label"><label for="account_number"
                                                                             class="inline"><spring:message
                                    code="sp.reprint_check.label.reason"/>
                                <font color="#FF00FF">*</font> </label></td>
                            <td width="199"><select name="select2" style="width:150px;">
                                <option value="upside" selected="selected">Printed upside down</option>
                                <option value="twice">Printed twice</option>
                                <option value="backside">Printed on backside</option>
                                <option value="burnt">Partialy /fully burnt</option>
                                <option value="other">Other - please type reason</option>
                            </select></td>
                            <td width="117" class="label"><label for="account_number" class="inline"><spring:message
                                    code="sp.reprint_check.label.reason_detail"/><font color="#FF00FF">*</font></label>
                            </td>
                            <td width="242"><textarea name="account_no2" cols="30" rows="5"></textarea></td>                
                        </tr>
                        <tr>
                            <td><input name="mailing_city" size="21" type="text"/></td>
                            <td class="label"><label for="account_number" class="inline"><spring:message
                                    code="sp.reprint_check.label.check_img"/><font color="#FF00FF">*</font></label></td>
                            <td colspan="2"><input type="file" name="logo2" id="logo2"/></td>
                            <td>&nbsp;</td>
                        </tr>
                        <tr>
                            <td><input name="submit3" type="submit" class="ui-button ui-state-default ui-corner-all"
                                       value='<spring:message code="sp.reprint_check.label.send_request"/>'/></td>
                        </tr>
                        </tbody>
                    </table>
                    <%@include file="../common/file_upload.jsp" %>
                    <br>

                    <p>&nbsp;</p>
                </form>
            </td>
        </tr>
    </table>

    <div class="contentArea">
    </div>
</div>
<%@include file="/WEB-INF/jsp/include/footer.jsp" %>
</body>
</html>